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Let’s Talk Specialty Pharmacies

I have had trouble writing and finishing this post. This draft has been sitting here on WordPress. It has been months in the making but I keep running into issues left, right and center and get side-tracked…and annoyed.

But, let’s start at the beginning. Three years ago my insurance company switched from Walgreens to Accredo Specialty Pharmacy. Strike one. Okay, that is a little unfair. Accredo used to be smaller. Customer service was super, it was easy to get medications, prescriptions and co-payment information were processed quickly. Now, as more medical insurance companies partner with Accredo, the pharmacy has grown…and not for the better.

When I was on self-injections (Humira, Enbrel & Orencia) I received an invoice every month. I received my medications every month. My personal and doctor’s prior authorization were valid for one year. They processed my co-payment assistance information quickly. When they validated a new prescription, the old one was voided and removed from the system so there was no confusion. It was easy sailing and hassle-free for everyone involved. Even writing this all down, I realize how easy I had it…

Eight months ago I switched from the Orencia self-injections to the IV infusion and everything went hay-wire.

The usual happened: new prior authorization. The following were added: okay the shipment, add the doctor’s office address, allow Accredo to contact my doctor’s office. Okay, all that makes sense, right? This should all be easy to do. APPARENTLY NOT.

Side Note: I stopped receiving my monthly invoices. Anyways…

Accredo shipped my medications one week late for the first THREE months because they claimed they did not have my “permission” to contact my doctor’s office to schedule shipment. “They were unable to reach me over the phone.” Riiight.

I spoke to my doctor’s assistant. We came up with a solution. After every IV infusion we call Accredo together. I “okay” the shipment and she schedules it.

Every month I ask: what is my co-payment? Accredo replies: $0. I never questioned it because a) I had co-payment assistance and b) my insurance covers brand-name medications after I fulfill the deductible. So, in September, I assumed everything was squared away.

Everything was smooth sailing for a few months. Accredo sent out my medications two weeks prior to when I needed it, I sat for the IV on time. Crisis resolved.

Nope, not quite…

I received a 2-month delinquent bill for over $800 and a darling note informing me if I did not pay the full balance Accredo would not send out my medications.

EXCUSE ME??

I received a call a few days later informing me my co-payment assistance was not valid and the drug company was rejecting all invoices.

Orencia told me my co-payment assistance is valid as long as I am on the medication. What changed?

There are two separate co-payment assistance programs, one for the subcutaneous injections and one for the intravenous injections. Sure, that makes sense. Wish someone had told me, but hey, compared to everything else going on this is pretty minor. Except, I have a huge bill squashing my credit history. No biggie. My financial future is not important.

But wait…didn’t I switch medications seven months ago? Why wasn’t this caught…say, seven months ago? Why was I not billed? Why was my co-payment $0! I’m pretty sure 0+0+0+0+0+0+0=0 and ≠ 800 (please correct me if I am wrong!) After weeks (weeks!) someone informed me the 800 dollars were from the January and February invoices.

“I’m sorry, I can only see your information is not valid, you need to re-apply with Orencia”. Helpful, thank you. Frustrating but simple to do.

Let’s backtrack to that $800. After all, that is a lot of money and I would like to see that re-solved. I like my money, I work hard for it and I like to spend it (yes I am and have always been a self-proclaimed shop-a-holic), I have four pets, I have pretty steady medical bills and medications. But, I do not want to throw away my money on things I know I should not be spending money on! Who does??

I re-applied for the infusion assistance and Accredo said I was accepted, however, Orencia was still rejecting the earlier invoices. But, my co-payment was now $5.

I called Orencia. My approval was still pending. In fact, I was not even in the system yet. Strike…I have totally lost count…Accredo. How was my assistance covered when they had not even heard of me?

I actually have an answer to this one!

They were using my old subcutaneous information. Of course it wasn’t going through!

What happened to voiding prescription information as it changed?

Speaking of which, when my insurance made changes in March, they required new doctor’s authorization for all brand name medications. We followed protocol.

In April, we hit another snag. We tried to schedule shipment and Accredo told us we needed prior authorization because it had expired. Why, you ask, after one month’s validity??

Because they were looking at the subcutaneous prescription, not the IV one.

Well, no wonder there was confusion.

When I’m feeling low, look who takes care of me!

Waiting to hear back about the refund for that first bill. But, in the mean time, let’s add to the insanity…

I called Accredo to schedule shipment for my May infusion and they told me they already delivered it to my doctor’s office…without my consent? They no longer need it every month. Good! But wait, there’s more.

Orencia is still rejecting the invoices and I have to pay out-of-pocket. I spoke to a customer service rep and updated the Orencia information. No wonder everything was rejected. They STILL had the Orencia subq. information up. They are now re-submitting every claim from January to the present so my next question is:”If I am paying out of pocket, why I am I not receiving bills?”

The rep transferred me to Billing. “Do you still reside in Colorado?”

“NO! AND I HAVEN’T BEEN FOR THREE YEARS!”

Over the last THREE years I have continuously told them to make my permanent residence the one I live at now. And every time they “say” they do. But somehow ALL my bills end up in Colorado.

I am beyond annoyed! Because of Accredo’s stupidity my credit score dropped this year. I very angrily told the person I was speaking with to look through my history. It clearly showed I paid my bills on time, days within them sending the bill. I asked him to look for any discrepancies.

He apologized profusely and said “No, I agree, anyone who should have taken the time to look through your account should have realized the last few months’ activity was erratic and unusual.”

He apologized for the trouble I had gone through because they could not disable my former residence properly and he contacted a supervisor to completely erase it from the system. Usually, all addresses are kept in the systems but old ones are “disabled” and the current becomes the first in line.

For whatever reason, nobody could disable my Colorado residence properly and as a result I was not getting my bills and then receiving delinquent ones.

Things seem to have simmered down, however, I still have not received a bill, or any information on a refund. Right now, I do not have the mental or physical energy to go through all the calls again. I am going to wait until I need to schedule the next shipment.

How about you? Are you one of the lucky ones with smooth sailing or have you have increasing problems with your insurance companies? Please comment! I really want to hear about your experiences!

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4 thoughts on “Let’s Talk Specialty Pharmacies”

Oh dear! What a nightmare! I know, that doesn’t even cut it.
I never thought I’d say this, but… I am glad we’ve got the NHS in the UK. You have to wait 3 months for a lousy ultrasound scan and there are treatment waiting lists (not kidding), but at least everyone’s in the NHS and you don’t have to bother with insurance companies…

I’m Canadian so it’s quite different here. Overall medical costs are lower, but you have to wait longer to get tests, procedures, surgery, etc. Of course, if you have money you can always choose to go private and pay.

It’s really tough on those without money. There’s a bad joke that you could die waiting for whatever test you need to diagnose whatever medical problem you have. It’s not funny at all, but it is what we deal with here.

That is the one thing I do really appreciate in the US. I do not know a lot about ObamaCare but I am fortunate to have private insurance. As long as I have references from doctors I do not have to wait too long for any tests or procedures!!